Abstract

The benefits of blood pressure lowering on the risk of cardiovascular disease are seen with all commonly used classes of antihypertensive drugs. Although different drug classes may have different effects on cause specific outcomes (such as myocardial infarction or stroke), no differences are observed between their overall effects on combined major cardiovascular end points. The choice of first line antihypertensive drug is therefore likely to be of less importance than the use of any effective drug, particularly since the majority of patients will need two or more agents to achieve blood pressure goals. Recent trials have provided good evidence that lowering cholesterol with statins reduces the risk of cardiovascular events in “high risk” patients, irrespective of initial cholesterol concentrations. The benefits of both blood pressure lowering and lipid lowering treatment appear to be proportional to the extent of the reduction of blood pressure and lipids achieved.